针刺组穴对脑梗死后偏瘫患者脑功能观察研究

发布时间：2018-01-22 01:52

本文关键词： 皮质下脑卒中偏瘫功能磁共振针刺局部一致性　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:利用静息态功能磁共振(rsfMRI)观察临床针刺组穴对急性或亚急性期皮质下梗死后偏瘫患者脑功能的影响,探讨临床常用针刺组穴治疗缺血性脑卒中后偏瘫发挥作用的可能神经机制,以期为针刺治疗卒中后偏瘫疗效提供内在可能理论依据。方法:本研究通过广州中医药大学第二附属医院广东省中医院伦理委员会批准。(批号:Y2016-013-01)收集2014年7月至2016年12月在广东省中医院住院治疗期间符合研究标准的左侧皮质下梗死病人共12例,随机分为经穴针刺治疗组和非经非穴对照组,分别进行10次针刺治疗,予治疗前后行静息态功能磁共振扫描和简化Fugl-Meyer运动功能评定量表(Simplified Fugl-meyer Motor Function Rating Scale,FMA)、改良巴氏指数评定表(Modified Barthel Index,MBI)功能评估。通过功能磁共振图像局部一致性(Regional Homogeneity,ReHo)分析方法观察组间脑功能变化情况;临床数据分析运用SPSS22.0进行统计,结果取P0.05认为有统计学意义。结果:1.临床行为学统计:治疗组与对照组组内治疗前后对比FMA、FMA上肢、MBI评分均有统计学意义(P0.05);治疗组和对照组组间对比FMA、MBI评分无统计学意义(P0.05);2.rsfMRI数据分析结果:基于ReHo分析方法显示,治疗组治疗后在左侧额上回内侧、左侧额中回、左侧额下回框部及左侧额框区、左侧顶下小叶、右侧尾状核ReHo值显著升高且以患侧脑激活簇增加显著,在双侧枕中回及楔回ReHo值降低;对照组治疗后在左侧额下回框部及左侧额下回局部脑区ReHo值升高,在左侧舌回及右侧小脑山坡ReHo值降低。结论:1.经穴针刺较之非经非穴针刺对大脑多个脑功能区有影响且在患侧脑区表现出显著激活,推测经穴针刺可能是通过对额叶脑区、顶下小叶及尾状核等多个节点的重建和调控对脑功能重组发挥作用并且患侧脑区的激活可能更有利于功能障碍的康复。2.经穴针刺和非经非穴针刺都能够提高患者的运动功能与日常生活能力,但由于样本量少、观察周期短等因素尚需要进一步观察二者的临床差异性。
[Abstract]:Objective: to observe the effect of acupuncture on cerebral function in patients with hemiplegia after acute or subacute subcortical infarction by resting functional magnetic resonance imaging (fMRI). To explore the possible neural mechanism of acupuncture group in the treatment of hemiplegia after ischemic stroke. Methods: this study was approved by the Ethics Committee of Guangdong Provincial Hospital of traditional Chinese Medicine, second affiliated Hospital of Guangzhou University of traditional Chinese Medicine. (. Batch number: Y2016-013-01) A total of 12 patients with subcortical infarction who met the study criteria during hospitalization in Guangdong Provincial Hospital of traditional Chinese Medicine from July 2014 to December 2016 were collected. They were randomly divided into acupoint acupuncture treatment group and non-meridian non-point control group, which were treated with acupuncture for 10 times respectively. Rest fMRI and simplified Fugl-Meyer motor function assessment scale (Fugl-Meyer) were performed before and after treatment (. Simplified Fugl-meyer Motor Function Rating Scale. Modified Barthel Index. The changes of diencephalon function in group B were observed by regional homogenicity analysis with regional consistency of functional magnetic resonance imaging (fMRI). Clinical data analysis using SPSS22.0 statistics, the results of P0.05 that there was statistical significance. Results: 1. Clinical behavior statistics: the treatment group and control group before and after treatment compared with FMA. The scores of FMA in upper limb were statistically significant (P 0.05). There was no significant difference in FMA-MBI score between the treatment group and the control group (P 0.05). 2. Results of rsfMRI data analysis: based on ReHo analysis, the treatment group showed that the left superior frontal gyrus, left middle frontal gyrus, left inferior frontal gyrus and left frontal box, left inferior parietal lobule after treatment. The ReHo value of the right caudate nucleus increased significantly and the activation cluster of the affected brain increased significantly, but the ReHo value decreased in the bilateral occipital middle gyrus and cuneate gyrus. The ReHo values of the left inferior frontal gyrus and the left inferior frontal gyrus in the control group increased after treatment. The ReHo value of left lingual gyrus and right cerebellar hillside was decreased. Conclusion: 1. Acupuncture at meridian points has effect on multiple brain functional areas compared with non-meridian point acupuncture, and shows significant activation in the affected brain area. It is speculated that acupuncture at the acupoints may be through the frontal lobe brain area. The reconstruction and regulation of several nodes, such as subparietal lobules and caudate nucleus, may play a role in the reconstitution of brain function and the activation of the affected brain area may be more beneficial to the rehabilitation of dysfunction .2.Acupuncture on the meridian and non-meridian acupuncture can both improve the function of the brain. Motor function and daily living ability of patients. However, because of the small sample size and short observation period, it is necessary to further observe the clinical difference between them.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.6

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